This document discusses the normal and abnormal constituents found in urine. It provides information on the typical composition and output of urine and how urine can be used to diagnose kidney and urinary tract abnormalities as well as systemic diseases. Common normal constituents of urine are listed along with how various substances may be elevated or reduced depending on conditions like diabetes or kidney dysfunction. The document also covers urine analysis techniques including physical, chemical, and microscopic examination and how to properly collect and preserve urine samples.

1. Abnormal constituents of
Urine

2. • Urine
- Water (95°
/o) &Solids (5°
/o)]
- Urinary out put: 1-1.5 L per day.
- Almost all substances found in urine are also find in
blood.
- may also contain cells, casts, crystals, mucus &
bacteria.

3. • Urine:
- Provides information about functioning &
abnormalities of kidneys &urinary tract
- Help in diagnosis of various systemic diseases [+nee
or - nee of several substances in urine]

4. Normal constituents of urine
Creatinine
UricAcid
Urea
ca++
PO4
3-
K+
0.8 - 1.8 gm/L
0.5 gm/L
25-30 gm/L
0.2 gM/L
1.7gm/L
1.7 gm/L
3.5 gm/L
6-16 gm/L
Na+
c1-

5. • Preservation
- For routine analysis, urine is best examined fresh.
- Bacterial growth will ruin a specimen if analysis is
delayed for >3 hrs.
- Refrigeration: best way to preserve if analysis is
delayed.
• Refrigeration for >24hrs isn't recommended.

6. • Chemicals used
- Toluene
- Thymol [for sugar estimation]
- Formalin
- Boric acid
- Camphor
- Toluol [for acetone estimation]
- Chloroform

7. Changes occur in non preserved specimen
Urea ---+ NH3
t Glucose
t KB
d/t bacterial utilization - -
d/t volatilization
- - -
1bilirubin d/t exposure to light
-
-
-
-
-
-
- - - -
i bacterial number
j turbidity bacteria & amorphous
Disintegration of RBCs casts
j nitrite
Changes in color
d/t bacterial reduction of nitrate
d/t oxidation or reduction of metabolite

8. URINE ANALYSIS
• Physical
• Chemical
• Microscopic

9. MACROSCOPIC EXAMINATION OF URINE
••
••
••
••
••
••
••
••
••
••
••
••
Color
Clarity
Odor
Volume
Specific gravity
pH

10. Color:
• Normal urine is of amber color due to +nee of urochrome
(urobillin &urobilinogen) in urine.
• Colourless: Dilute urine
• Dark: Concentrated urine.
Colorless
-
YHigh fluid intake
y L
Jse of diuretic
YDM
YDI
YAlcohol
Dark
-
Y ow fluid intake
YExcessive sweating
YDehydration (burns, fever)

11. Abnormal colour of urine
Cloudy Excess P04, Urates, Pus cells, Bacterial contamination
Red Frank Hematuria, hemoglobinuria, Myoglobinuria,
Intake of Pyridium, Phenolphthalein
Ingestion of Beet root, Black berries
Deep yellow
Greenish
Obstructive Jaundice, Ingestion of Vitamin B complex
Obst. Jaundice [excess Billirubin or billiverdin]
Phenol poisoning
Blue
Brown black
Methylene Blue poisoning
Hemorrhage in bleeding, Acidic urine, Porphyria
Black
Milky
Cola
Alkaptonuria
+nee of Chyle
Nephritic syndrome

12. Clarity (Transparency)
• Normal urine clear or transparent
• Any turbidity will indicate +nee of either of the following:
• WBCs (pus).
• RBCs
• Epithelial cells
• Bacteria
• Casts
• Crystals
• Lymph
• Semen
• Phosphate

13. ODOR
Ketoacidosis
Phenylketonurea
Normal fresh urine
-
-
Standing for long time
Bacterial action of pus (UTI)
Faint aromatic odor
Ammoniac odor
d/t +nee of volatile acids
Offensive odor
- -
Fruity odor
Mousy odor
- - - - r

14. VOLUME
Oligouria
Polyuria
Anuria
Nocturia
- -
j urination during
night
l]
t in urine flow
-
j in urine
flow
- [< 400 m
- - -
[> 2500 ml]
<100ml/day
600 - 2500 ml /24hr 0.5-1ml /kg/hr
Children 200-400ml/24hr 4ml/kg/ hr

15. • Causes of anuria:
• Severe Renal Defect
• Loss of urine formation mechanism.
• Due to +nee of stone or tumor.
• Post transfusion hemolytic reaction.
• Incompatibility between donor's &receiver's blood
hemolysis excess Hb causes
renal tubules acute renal failure.
blockage of

16. Causes of polyuria: Causes of Oliguria:
jed fluid intake- -
jed salt & protein intake
Addison's disease
Intravenous saline or glucose
Chronic glomerulonephri tis
Diuretics intake
Psychogenic polydip
-sia
- -
DM
DI
Water deprivation
Dehydration
- -
Prolonged vomiting
Diarrohea
Excessive sweating
Acute renal failure
Renal lschem ia
Obstruction
[Calculi,Tumor, Prostatic hypertrophy]

17. • pH
One of imp. functions of kidney is pH regulation.
Blood pH: 7.4 &urine pH: - 6.0 (4.6 - 8.0)
[due to secretion of H+ &reabsorption of HC03-]
Urine pH 9, indicate that urine is stand for a long
time &must be rejected.
Acidic urine
- Alkaline urine
Acidosis Alkalosis
UTI [Proteus]
OKA
Starvation
Dehydration
- -
RT
A
Vegetarian diet
-
-
Diarrhea
E. coli infection
Muscular fatigue

18. Clinical significance of pH
1. Determine existence of acid base disorder.
2. Precipitation of crystals to from stone requires specific
pH for each type.
• Hence, pH control may inhibit formation of these
stones.
Crystals in acidic urine Crystals in alkaline urine
Ca oxalate Ca carbonate
-
-
Uric acid Ca phosphate
Mg Phosphate
-
-

19. Specific gravity
• Normal: 1.015-1.025.
• Theoretical extremes: 1.003 to 1.032.
• Contamination during collection &storage gives false value.
Sp. gravity is jed in
•DM [Glycosuria]
_ _ _ _ ...
•Nephrosis [Albuminuria]
•All cases of oliguria
-
- - - - - '
•Hematuria
•Hemoglobinuria
Sp. gravity is t ed in
•Excessive water intake
•DI
•Chronic glomerulonephritis
•All cases of polyuria [except DM]
•Execessive sweating

20. • Low fixed specific gravity
- Due to loss of concentrating ability by damaged tubule,
sp. gravity of urine is fixed at 1.010.
- Found in:
• Chronic glomerulonephritis-end stage kidney
• ADH def.
• Polycystic kidney
• Chronic pyelonephritis

21. • Chemical examination of Urine
Sugar
Protein
KB
Hb
Blood
Mucin
Bile salt
Bile pigment
Porphyrin
5-HIAA

22. • Urine examination for +nee of Sugar
- Glycosuria is defined as presence of sugar in urine in
a amount that can be detected by chemical methods.
- Reducing subst. found in urine:
Sugar Non-sugar
Glucose [DM, Endocrine disorder]
Lactose [Pregnancy, Lactation]
CHCl3, Formaldehyde [preservative]
Homogentistic acid
Fructose Ascorbic acid

23. Hyperglycemic glycosuria
• Blood glucose > Renal threshold for glucose
glycosuria
• Occurs in Endocrinal disorder
» DM
» Cushing's syndrome
» Hyperpituitarism
» Hyperadrenalism

24. • Alimentary Glycosuria
High glucose intake at once for > 1 week
!
t ed tolerance of body for glucose
!
Glycosuria

25. Renal glycosuria
Defect in renal tubule
!
Subsequent lowered renal threshold for glucose
!
Glycosuria
• Occurs in:
- RT
A
- Heavy metal poisoning
- Fanconi's Syndrome

26. Benedict's Test
• General test for Reducing sugars
• Reagent's composition:
26
CuS04 17.3gm
Na2C03 1OOgm Provide alkaline medium
Na-Citrate
Dist. water
173gm
1OOO
ml
Cu++ chelating agent [slowly releases Cu++
]

27. Benedict's Test
• Copper reduction test in alkaline medium
• Principle:
- Reducing sugars under alkaline medium, tautomerise
to form enediols (powerful reducing agent), which
reduces cu++ to cu+.
CuS04 Cu++ + SQ4--
Cu++ + Na-citrate
Reducing sugar
Enediol + Cu++
Cu-Na-citrate complex
Enediol
Cu+ + sugar acids
Cu+ + OH-
2 CuOH
CuOH
Cu20 ( !)
27

28. • Procedure
- 5 ml of Benedict's reagent was taken in a test tube.
- 8 drops of urine was added.
- Mixed well.
- Boiled for 2 min
- Cooled &color was observed.
Observation Inference
Sample B

29. Benedict's Test
Yellow to red PPT +++ 1.5-2.0 gm0
/o
Brick Red PPT ++++ >2.0 gm0
/o
• Final color formed is dependent on amount of reducing
sugars +nt in given sample, thus benedict's test is known
as Semi-quantitative test.
29
Blue color -ve
Green colour Trace < 0.5gm0
/o
Green PPT + 0.5-1.0 gm0
/o
Green to yellow PPT ++ 1.0 - 1.5 gm0
/o

30. KETONURIA
• Usually found ketone bodies in human body &urine are:
-Hydroxy butyrate --Acetoacetate------ Acetone
[Primary]
• Normal level of ketone bodies in blood: 70mg/dl
• Renal threshold for ketone bodies: 1mg/di
• normallly excreted in urine. [<20mg/day]
jed KB in urine
Intake of high fat & low carbohydrate diet
Starvation
Uncontrolled DM
Prolonged vomiting